TB And AIDS An Increasingly Toxic Mix

by Isaac Baker

(IPS) UNITED NATIONS -- Despite the fact that it is a curable disease, tuberculosis killed more people than all wars, earthquakes, floods, tsunamis, airline accidents, terrorist acts and murders worldwide in the past year, according to a report released Mar. 24 to mark World Tuberculosis (TB) Day.

While treatment for TB, which infects an estimated one in three people worldwide and kills nearly two million people a year, is both effective and inexpensive, millions of the developing world's infected people are being deprived of the treatment they need to survive.

"Tuberculosis was last year's most overlooked tragedy," said Dr. Bobby John, president of the Massive Effort Campaign, a network of non-governmental organizations working on HIV/AIDS, TB and malaria that issued the "Global TB Report Card 2005."

"The deaths of these 1.8 million people were arguably all the more tragic as almost every one of them could have been prevented if they had been properly treated with highly-effective anti-TB medicines," he said.

TB is primarily an illness of the respiratory system, and is spread by coughing and sneezing. While the disease has been all but eliminated in many wealthy Western nations, it is by no means beaten.

TB disproportionately affects developing countries, which contain an estimated 98 percent of the world's TB infections. Some 80 percent of TB infections occur in only 22 "high-burden countries" (HBCs).

Malnutrition, unsanitary living conditions, and especially HIV/AIDS weaken the immune systems of poor people, leaving them far more vulnerable to TB infection than those in wealthier nations.

Neglect by Western governments as well as developing nations has made a completely curable disease a nightmare for the world's poor, health activists say.

"Most wealthy countries think of TB as a disease of the past," Joanne Carter, legislative director of RESULTS International, which co-sponsored the "Report Card," told IPS.

"When people die in a plane crash or a tsunami or another major disaster with a fixed place and time, these tragedies register more intensely on the global scene," she said. "But when every day 5,000 people die in villages and shanty towns all over the world from a curable disease, there is only silence."

Anti-TB medicines cost a mere 10 to 12 dollars. The World Health Organization (WHO) reports that these inexpensive treatments cure some 85 percent of TB cases.

"With a full course of drugs to treat TB costing just 10 dollars, it is unfathomable that anyone who needs treatment should die," the RESULTS report says. "And yet, this is the tragic scenario that is repeated every day around the world."

In order to be effective, the treatment, called Directly Observed Treatment Short-Course (DOTS) strategy, must be continued for six straight months. If the treatment is stopped or is continued in infrequent intervals due to lack of funds or other reasons, drug resistant strains of TB can and have developed. This makes full treatment all the more vital, health experts say.

"From a public health perspective, poorly supervized or incomplete treatment of TB is worse than no treatment at all," the WHO says.

While TB prevalence rates have fallen 20 percent since 1990 and are stabilizing in many parts of the world, the disease continues to terrorize regions like Southeast Asia, which saw an estimated three million new cases, and Eastern Europe, which has an increase in TB deaths after four decades of decline, according to the Global Fund to Fight Aids, Tuberculosis and Malaria (GFATM).

GFATM estimates that, if current trends continue, by 2020 nearly 1 billion people will be newly infected with TB and the disease will have claimed 35 million lives.

In Africa, TB prevalence has tripled since 1990 and the disease continues to grow by three to four percent annually, largely due to the deadly combination of TB and HIV/AIDS.

Nearly one in three people whose immune systems have been weakened by HIV/AIDS will become infected with TB, which is the single largest killer of HIV/AIDS victims.

On Thursday, WHO Director General Dr. Lee Jong-wook reiterated the need to incorporate TB treatment into the global fight against AIDS.

Jong-wook quoted former South African President Nelson Mandela, who last year said, "TB is too often a death sentence for people with AIDS. We can't fight AIDS unless we do much more fight TB as well."

While much progress has been made in combating the disease in recent years, reports issued Thursday by the WHO, RESULTS International, and others show that many nations of the world have failed the goals set for TB detection and the DOTS treatment.

The WHO's goal was to reach a 70 percent TB detection rate by 2000. Since the goal was not met, the deadline was pushed back to 2005. However, the WHO report, which is based on statistics from 2003, shows a detection rate of only 45 percent.

Out of the 22 HBCs, only Vietnam has reached the case detection goal.

"Evidence in this report provides real optimism that TB is beatable," Jong-wook said Thursday. "But it is also a clear warning."